cisplatin + nintedanib + pemetrexed

This is a combination regimen consisting of three drugs—cisplatin, nintedanib, and pemetrexed—used primarily in the treatment of unresectable malignant pleural mesothelioma. Cisplatin is a platinum-based chemotherapy agent that causes DNA crosslinking and apoptosis in cancer cells. Pemetrexed is an antifolate antineoplastic agent that inhibits enzymes involved in folate metabolism and DNA synthesis, thereby preventing cancer cell replication[7][10]. Nintedanib is an oral small molecule tyrosine kinase inhibitor targeting vascular endothelial growth factor receptors (VEGFR 1-3), platelet-derived growth factor receptors (PDGFR α/β), fibroblast growth factor receptors (FGFR 1-3), as well as Src and Abl kinases; these pathways are implicated in tumor angiogenesis, proliferation, and metastasis[1][2][9]. The combination has been studied as first-line therapy for patients with unresectable epithelioid malignant pleural mesothelioma. Clinical trials have shown improved progression-free survival compared to standard chemotherapy alone[2][5].